Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review
This study aimed to systematically review cost-effectiveness studies of newer antidiabetic medications.
The PubMed/MEDLINE, EMBASE, CINAHL Plus, Cochrane Library–NHS Economic Evaluation Database (Wiley), Cochrane Library–Health Technology Assessment Database (Wiley), Cochrane Library–Database of Abstracts of Reviews of Effects (Wiley), and the Cost-Effectiveness Analysis Registry databases (from 1 January 2000 to 1 June 2018) were searched. The search strategies included the Medical Subject Heading (MeSH) term ‘economics’, and the MeSH entry terms ‘cost’, ‘cost effectiveness’, ‘value’, and ‘cost utility’, as well as all names for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. Inclusion criteria included (1) cost-effectiveness studies of the newer antidiabetic medications, including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors; and (2) full-text publications in English. Two reviewers independently screened the titles, abstracts, and full-text articles to select studies for data extraction. Discrepancies were resolved by discussion and consensus. The quality of reporting cost-effectiveness analyses was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guideline.
Among 85 studies selected, 82 clearly stated the types of diabetes model used (e.g. CORE model), and 70 studied used validated diabetes models. Seventy-four (87%) studies were funded by pharmaceutical companies, and 72 (85%) studies were conducted from a payer’s perspective. Seventy-six (89%) studies presented were of good quality (20–24 CHEERS items), and nine were of moderate quality (14–19 items). Thirty studies compared newer antidiabetic medications with insulin, 3 studies compared newer antidiabetic medications with thiazolidinediones (TZDs), 15 studies compared newer antidiabetic medications with sulfonylureas, 40 studies compared new antidiabetic medications with alternative newer antidiabetic medication, and 9 studies compared other antidiabetic agents that were not included above. Newer antidiabetic medications were reported to be cost-effective in 26 of 30 (87%) studies compared with insulin, and 13 of 15 (87%) studies compared with sulfonylureas.
Most economic evaluations of antidiabetic medications have good reporting quality and use validated diabetes models. The newer antidiabetic medications in most of the reviewed studies were found to be cost effective, compared with insulin, TZDs, and sulfonylureas.
Lizheng Shi and Dongzhe Hong formulated the study question. Dongzhe Hong also drafted the data abstraction form and the project proposal, and developed the search strategies for study selection; all other authors reviewed and revised the search strategies and the study materials. Dongzhe Hong and Minghuan Jiang screened the titles and abstracts, and extracted articles for full-text review. Hui Shao, Yingnan Zhao, Yan Li, and Lizheng Shi performed the critical appraisal of the studies. Dongzhe Hong, Lei Si, Minghuan Jiang, and Wai-kit Ming abstracted data from the selected articles, and Dongzhe Hong conducted the data synthesis. Dongzhe Hong also drafted the Methods and Introduction sections of the manuscript, and Lei Si drafted the Introduction, Discussion, and Conclusions sections. All authors reviewed and revised the manuscript.
Compliance with Ethical Standards
This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of Interest
Lei Si is a recipient of the National Health and Medical Research Council Early Career Fellowship (GNT1139826). Yan Li was partly supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL141427. Dongzhe Hong, Minghuan Jiang, Hui Shao, Wai-kit Ming, Yingnan Zhao, and Lizheng Shi have no conflicts of interest to declare.
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